Dietetic Internship Handbook · June 2010 and served one year. Dr. Lynn Burney was the DI Director...

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Transcript of Dietetic Internship Handbook · June 2010 and served one year. Dr. Lynn Burney was the DI Director...

Dietetic Internship Handbook

Mississippi State University Food Science, Nutrition, and Health Promotion Department

Box 9805 Mississippi State, MS 39762-9805

Amended May 2019

Approved

Table of Contents Page

Introduction..........................................................................................................................5

General Information Program History.......................................................................................................5 Food Science, Nutrition, and Health Promotion Department Head and Faculty.....6 MSU DI Program Mission .......................................................................................6 MSU DI Program Goals...........................................................................................6 MSU DI Program Objectives...................................................................................6 Role of Dietetic Internship in the Credentialing Process.........................................7 Dietetic Intern Responsibilities................................................................................7 Current Accreditation Standards for DI Programs...................................................8 Prior Leaning ...........................................................................................................8 The Concentration of the MSU DI...........................................................................8 Accreditation Status of the MSU DI........................................................................8 The 2017 Accreditation Standards for DI Programs................................................8 Coursework towards the Master of Science...........................................................10 Graduation and Program Completion Requirements.............................................10 Professional Meetings............................................................................................11 Project ....................................................................................................................11 Fees and Expenses ................................................................................................ 11 Financial Aid..........................................................................................................11 Estimated Expenses for MSU Dietetic Internship Program ..................................12

Policies and Procedures Withdrawal from the University ............................................................................13

Release of Directory Information ......……………………………………………15 Release of Educational Records.....………………………………………………15

Withdrawal from an Individual Course .................................................................13 Refunds of Tuition and Fees ..................................................................................13 Insurance Requirements, including those for professional liability.......................13 Special Needs.........................................................................................................13 MSU Honor Code ..................................................................................................13 Statement of Equal Opportunity ............................................................................14 Protection of Private Information/Access to Personal Files ..................................14

Professional Behavior ............................................................................................16 Professional Appearance........................................................................................17 Liability for Safety in Travel to and from Assigned Areas ...................................17 Inclement Weather ................................................................................................17 Physical Exam/Immunization/Health Record .......................................................17 Exposure to Infectious Diseases ...........................................................................17 Injury and/or Illness ...............................................................................................18 Drug Testing and Criminal Background Checks ...................................................18

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Attendance Policy ..................................................................................................18 Leave of Absence...................................................................................................18 Vacation, Holidays, and Absences.........................................................................18 Cell Phones, etc......................................................................................................19 University Academic Calendar ..............................................................................19 Grievances..............................................................................................................19 Disciplinary Process/Termination..........................................................................19

Evaluation Written Assignments..............................................................................................20 Student Performance and Practice Evaluation.......................................................20 Forms .....................................................................................................................21 Procedure for Evaluation at Each Site ...................................................................21 Procedure for Competency Checklist at Each Site ................................................21 Prior Learning ........................................................................................................21

Tips for Success during Supervised Practice .....................................................................22

Code of Ethics for the Profession of Dietetics...................................................................24

Contact Information for the MSU DI Director ..................................................................26

Facilities Baptist Memorial Hospital-Golden Triangle .........................................................26 Fresenius Medical Center West Point/Golden Triangle/Starkville........................27 Mississippi State Department of Health ................................................................27 Mississippi State University Extension Service ....................................................28 North Mississippi Medical Center-Tupelo.............................................................29 Student Health Center Mississippi State University..............................................30 Choctaw Indian Reservation/Food Distribution Center.........................................30 Starkville School District Food Service.................................................................30 North Mississippi Medical Center (Food Service) West Point..............................31 Mississippi State University- Research .................................................................31 Aramark Foodservice Mississippi State University...............................................32 Mississippi State University Sports Nutrition........................................................32 School Foodservice Growing Healthy Waves .......................................................33 Estimated Mileage and Travel Costs to Facilities..................................................34

Appendix (listed in order)..................................................................................................36 Mississippi State University Dietetic Internship Booklist MSU Dietetic Internship Dress Code Policy Rotation Format Rotation Evaluation Intern Rotation Evaluation Mississippi State University Dietetic Internship Program Graduate Survey

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Intern Competency Checklist Dietetic Intern Immunization Form Healthcare Criminal History Background Affidavit Important Contact Information Dietetic Intern Handbook Form

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Introduction The Mississippi State University (MSU) Dietetic Internship (DI) offered in the Food Science, Nutrition, and Health Promotion department, is an innovative post-baccalaureate program designed to prepare interns for rewarding careers in traditional and nontraditional roles. Interns complete the requirements for the DI and nine hours of graduate credit within 11 months.

The MSU DI provides supervised practice experience in a variety of clinical, food service management, research, community nutrition, and nutrition education settings. Interns work with faculty and preceptors in outpatient clinics, various inpatient settings, community settings, classrooms, and other locations to acquire skills and broaden their understanding of dietetics. Upon completion of the DI, graduates are prepared for the Registration Examination of the Commission on Dietetic Registration (CDR), as well as entry-level practice.

General Information

Program History The MSU Pre-Professional Practice Program (AP4) preceded the DI. The AP4 was approved by the Commission on Accreditation for Dietetics Education (CADE) in August 1990. Fourteen students completed the AP4 requirements under the leadership of Dr. Betty Ector between 1990 and 1996. In 1994 CADE voted to convert all AP4 programs to DI’s by 2000. In July 1995, the MSU nutrition faculty formed a design team consisting of Dr. Shirley Hastings, Dr. Catherine Boyd, Dr. Betty Ector, Dr. Wanda Dodson, Dr. Sylvia Byrd, and Ms. Carolyn Malone. Team members participated in national meetings and training workshops, and provided leadership to conduct the self-study to become an accredited DI. Additionally, input was obtained from meetings held with the Foods, Nutrition, and Dietetics Advisory Board members and AP4 alumni. Developmental accreditation status was obtained in 1995. The self-study was completed and submitted to CADE in July 1996. Dr. Sylvia Byrd was then appointed Program Director in July 1996. The site visit was conducted September 16-17, 1996. In December 1996, the MSU DI/Graduate Studies Program was accredited by CADE.

Dr. Michelle L. Lee was DI Director 2006 – 2010. Dr. Diane K. Tidwell became the DI Director in June 2010 and served one year. Dr. Lynn Burney was the DI Director July 2011 – December 2012. Ms. June Renee Matich was Director January to February 13, 2013. Dr. Diane K. Tidwell became the DI Director on February 14, 2013.

The start date for the MSU DI is the second summer term, which is usually in the beginning of July. This will allow any MSU graduate to be eligible to begin the internship if he/she is finishing coursework for the Bachelor of Science degree in first summer term.

Interns complete the MSU DI over an 11-month period beginning in July.

MSU Academic Calendars are available at https://www.registrar.msstate.edu/calendars/academic-calendar/

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Food Science, Nutrition, and Health Promotion Department Head and Faculty (Current as of April 18th, 2019)

Will Evans PhD, MCHES, Department Head and Professor, December 2015 - present K.C. Sam Chang, PhD, Professor, Director Mississippi Center for Food Safety and Post –Harvest Technology Juan L. Silva, PhD, Professor of Food Science and Graduate Coordinator Sylvia H. Byrd, PhD, RD, Professor and Project Director Brent J. Fountain, PhD, RD, Associate Extension Professor of Nutrition Barry P. Hunt, Professor of Health Promotion Mandy Conrad, MS, RD, Assistant Professor of Nutrition M. Wes Schilling, PhD, Professor, Undergraduate Advisor, Food Science Diane K. Tidwell, PhD, RD, Professor Emeritus Fauzia Khan, MD, PhD, Part-time Lecturer, Nutrition Kelly White, MS, RD, CSSD, Part-time Lecturer, Nutrition David R. Buys, PhD, Assistant Extension and Research Professor Wen-Hsing Cheng, PhD, Associate Professor Ramakrishna Nannapaneni, PhD, Associate Research Professor Brittney Oliver, PhD, Assistant Professor of Health Promotion Susan Street, MS, Lecturer Terezie Tolar Mosby, EdD, RD, Associate Professor and Dietetic Internship Director, August 2015-present Judy Bonner PhD, RD, Professor, Provost and Executive Vice President Courtney Crist PhD, Assistant Extension Professor Antonio Gardner PhD, Assistant Professor Ron Williams, Lecturer Ann Sansing, Extension Instructor J. Mike Martin, Lecturer William Gillis, Lecturer Michael Hall, Lecturer

MSU DI Program Mission The mission of the Mississippi State University Dietetic Internship (MSU DI) is to provide supervised practice experience which instills in dietetic interns ideals of diversity, citizenship, leadership, and service, and to provide an integrative approach to foods, nutrition, and health and prepare interns who are competent entry-level registered dietitian nutritionists. The program accomplishes this mission through learning experiences in a variety of practice settings with diverse populations, contrasting delivery systems, and research oriented graduate education.

MSU DI Program Goals 1. Graduates are employed as competent entry-level registered dietitian nutritionists. 2. Graduates are engaged leaders who work within diverse populations.

MSU DI Program Objectives Goal # 1:

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a. Based on graduate surveys conducted 3 months post-graduation, 100% of interns will self-rate a competency level of “3-adequate” or “4-more than adequate” for overall preparation for entry-level dietitian nutritionist (based on 4 point scale).

b. The program’s one-year pass rate (graduates who pass the registration exam within one year of first attempt) on the CDR credentialing exam for dietitian nutritionists is at least 80%.

c. At least 80% of program interns complete program requirements within 16.5 months (150% of the program length).

d. Of graduates who seek employment, 80 percent are employed in nutrition and dietetics or related fields within 12 months of graduation.

e. 80% of program graduates take the CDR credentialing exam for dietitian nutritionists within 12 month of program completion.

f. At least 80% of employers will respond “3-good” or “4-excellent” that the internship adequately prepared graduates for entry-level practice

Goal # 2: a. Five years post completion of the program at least 25% of graduates will work with diverse

populations in service-oriented settings. b. Five years post completion of the program at least 25% of graduates will obtain leadership or

management positions.

Role of Dietetic Internship in the Credentialing Process You have completed the first step in becoming a registered dietitian (RD) by successfully completing an accredited ACEND (Accreditation Council for Education in Nutrition and Dietetics, formerly CADE) Didactic Program in Dietetics (DPD) academic program, providing at least a bachelor’s degree. Currently, you are enrolled in an ACEND accredited DI that will provide supervised practice experience and nine hours of graduate credit. Upon successful completion of the DI, the DI director will prepare and sign a Verification Statement of Completion of the MSU DI and send a copy to CDR that indicates eligibility to take the Registration Examination for Dietitians, which you will be able to schedule. Most states require licensure of dietitians to be able to work in some jobs such as nursing homes and hospitals. Requirements for licensure vary by state. You should contact the licensing agency in the state in which you wish to work.

Dietetic Intern Responsibilities The MSU Dietetic Interns have the following responsibilities:

1. Abide by the rules, regulations, policies, and procedures set forth by the MSU Graduate School. 2. Abide by the Code of Ethics for the Profession of Dietetics. 3. Abide by the rules, regulations, requirements, policies, and procedures of each site. Interns

must demonstrate personal cleanliness, appropriate dress and appearance, attention to detail, promptness, tactfulness, consideration of others, respect, adaptability, initiative, integrity, a positive attitude, professionalism, and responsibility at all times.

4. Always adhere to all confidentiality policies. Interns must maintain the facility/agency/ patient/client’s right to privacy. Patient and employee information is considered confidential (documented and undocumented information). Do not discuss patients or their cases on the elevator, in the cafeteria, halls, or anywhere that may violate confidentiality. Any type of misuse of confidential information may result in dismissal from the MSU DI.

5. Consider the DI as the equivalent of a full-time job. 6. Be punctual and available throughout the rotation. 7. Be prepared for each rotation by reading required materials (texts, papers, articles, etc.) and

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completing assignments prior to or during each rotation. 8. Communicate with preceptors throughout each rotation and the program. 9. Inform preceptors and the DI Director of any change in his/her schedule in a timely manner and

accept program changes that may arise. 10. Maintain a positive and hard-working attitude. 11. Leave muted/silenced cell phones in purse or desk. This includes no text messaging or using

any type of social media during scheduled working/internship hours.

Current Accreditation Standards for DI Programs were approved in 2017 by ACEND of the Academy of Nutrition and Dietetics (A.N.D.), formerly CADE of the American Dietetic Association (ADA). ACEND is the Academy's accrediting agency for education programs that prepare students for careers as registered dietitians (www.eatright.org/ACEND). ACEND serves and protects the public by assuring the quality and continued improvement of nutrition and dietetics education programs. ACEND is a specialized accrediting body recognized by the United States Department of Education.

Requirements and accreditation standards state that all Dietetic Internships must have at least 1200 hours of supervised practice.

Prior Learning: All interns will be assessed for prior learning and given up to 300 supervised practice hours for the prior learning.

Per accreditation standards, DI’s have the flexibility to define at least one (but not more than two) concentrations that builds on the foundation knowledge and competencies. The DI will name and define the concentration(s) based on available resources.

The Concentration of the MSU DI is Nutrition Education and Therapy.

Accreditation Status of the MSU DI: The MSU DI is currently accredited by ACEND.

The 2017 Accreditation Standards for DI Programs (Core Competencies for the RD)

1. Domain/ Scientific and Evidence Base of Practice: Integration of scientific information and translation of research into practice.

Competencies Upon completion of the program, graduates are able to: CRDN 1.1 Select indicators of program quality and/or customer service and measure achievement of objectives. CRDN 1.2 Apply evidence-based guidelines, systematic reviews and scientific literature. CRDN 1.3 Justify programs, products, services and care using appropriate evidence or data. CRDN 1.4 Evaluate emerging research for application in nutrition and dietetics practice. CRDN 1.5 Conduct projects using appropriate research methods, ethical procedures and data analysis. CRDN 1.6 Incorporate critical-thinking skills in overall practice.

2. Domain/ Professional Practice Expectations: Beliefs, values, attitudes and behaviors for the professional dietitian nutritionist level of practice.

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Competencies Upon completion of the program, graduates are able to: CRDN 2.1 Practice in compliance with current federal regulations and state statutes and rules, as applicable, and in accordance with accreditation standards and the Scope of Nutrition and Dietetics Practice and Code of Ethics for the Profession of Nutrition and Dietetics. CRDN 2.2 Demonstrate professional writing skills in preparing professional communications. CRDN 2.3 Demonstrate active participation, teamwork and contributions in group settings. CRDN 2.4 Function as a member of interprofessional teams. CRDN 2.5 Assign duties to NDTRs and/or support personnel as appropriate. CRDN 2.6 Refer clients and patients to other professionals and services when needs are beyond CRDN 2.7 Apply leadership skills to achieve desired outcomes. CRDN 2.8 Demonstrate negotiation skills. CRDN 2.9 Participate in professional and community organizations. CRDN 2.10 Demonstrate professional attributes in all areas of practice. CRDN 2.11 Show cultural competence/sensitivity in interactions with clients, colleagues and staff. CRDN 2.12 Perform self-assessment and develop goals for self-improvement throughout the program. CRDN 2.13 Prepare a plan for professional development according to Commission on Dietetic Registration guidelines. CRDN 2.14 Demonstrate advocacy on local, state or national legislative and regulatory issues or policies impacting the nutrition and dietetics profession. CRDN 2.15 Practice and/or role play mentoring and precepting others.

3. Domain/ Clinical and Customer Services: Development and delivery of information, products and services to individuals, groups and populations.

Competencies Upon completion of the program, graduates are able to: CRDN 3.1 Perform the Nutrition Care Process and use standardized nutrition language for individuals, groups and populations of differing ages and health status, in a variety of settings. CRDN 3.2 Conduct nutrition focused physical exams. CRDN 3.3 Demonstrate effective communications skills for clinical and customer services in a variety of formats and settings. CRDN 3.4 Design, implement and evaluate presentations to a target audience. CRDN 3.5 Develop nutrition education materials that are culturally and age appropriate and designed for the literacy level of the audience. CRDN 3.6 Use effective education and counseling skills to facilitate behavior change. CRDN 3.7 Develop and deliver products, programs or services that promote consumer health, wellness and lifestyle management. CRDN 3.8 Deliver respectful, science-based answers to client questions concerning emerging trends. CRDN 3.9 Coordinate procurement, production, distribution and service of goods and services, demonstrating and promoting responsible use of resources. CRDN 3.10 Develop and evaluate recipes, formulas and menus for acceptability and affordability that accommodate the cultural diversity and health needs of various populations, groups and individuals.

4. Domain/ Practice Management and Use of Resources: Strategic application of principles of management and systems in the provision of services to individuals and organizations.

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Competencies Upon completion of the program, graduates are able to: CRDN 4.1 Participate in management of human resources. CRDN 4.2 Perform management functions related to safety, security and sanitation that affect employees, customers, patients, facilities and food. CRDN 4.3 Conduct clinical and customer service quality management activities. CRDN 4.4 Apply current nutrition informatics to develop, store, retrieve and disseminate information and data. CRDN 4.5 Analyze quality, financial and productivity data for use in planning. CRDN 4.6 Propose and use procedures as appropriate to the practice setting to promote sustainability reduce waste and protect the environment. CRDN 4.7 Conduct feasibility studies for products, programs or services with consideration of costs and benefits. CRDN 4.8 Develop a plan to provide or develop a product, program or service that includes a budget, staffing needs, equipment and supplies. CRDN 4.9 Explain the process for coding and billing for nutrition and dietetics services to obtain reimbursement from public or private payers, fee-for-service and value-based payment systems. CRDN 4.10 Analyze risk in nutrition and dietetics practice.

Coursework towards the Master of Science in Food Science, Nutrition, and Health Promotion Requirements: Interns will complete nine hours of graduate coursework (3-hour course in the summer, 3-hour course in the fall and 3-hour course in the spring) and the requirements for the DI program within 11 months.

The Verification Statement is issued upon the successful completion of the supervised practice rotations and nine hours of graduate coursework. Interns must continually be enrolled at MSU and making progress until completion of the DI program. Dietetic Interns are classified as full-time graduate students from July–May and are enrolled in 9 hours (9 credits) each semester (except for summer). During 2nd summer term, interns will enroll in FNH 8273 Advanced Clinical Nutrition (3 credits), during the fall semester, interns will enroll in FNH 8286 Supervised Practice Experience (6 hours/credits) and one 3-hour graduate course. The spring semester, interns will enroll in FNH 8286 Supervised Practice Experience (6 credits) and one 3-hour graduate course.

Graduation and Program Completion Requirements The following components must be successfully completed to receive a Verification Statement, which qualifies the intern to sit for the Registration Examination for Registered Dietitians:

Performance will be evaluated on an ongoing basis throughout and at the end of each rotation. Satisfactory performance and practice skills must be demonstrated throughout the program as evaluated by each site coordinator or preceptor. Dietetic interns are eligible for graduation from the program when assignments are completed satisfactorily and when the intern has been in supervised practice for the required number of hours. All competencies (CRDs) for entry-level dietitians must be met by graduation. Dietetic interns who successfully complete the program will receive a signed program Verification Statement and will be eligible to sit for the national examination.

Interns are expected to complete all requirements of the program in 11 months. The maximum amount of time allowed for completing the program is one year, or twelve months. If an intern

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cannot complete all requirements in 11 months due to extraordinary circumstances, the DI director, site coordinator and/or preceptor will work to reach a consensus with the intern to enable the intern to complete the requirements of the program in a timely manner. If, for some reason, an intern must take a leave of absence, guidelines are provided for a leave of absence on page 16 of this handbook.

Professional Meetings: Interns are expected to become student members of A.N.D. by the time they enter the DI program. During the DI program, interns are required to attend specific professional meetings, such as the annual FNCE meeting, Mississippi Academy of Nutrition and Dietetic meeting and the Northeast District Mississippi Academy of Nutrition and Dietetic meetings. Additionally, many interesting and informative workshops are offered within the northeast Mississippi area and are sponsored by local hospitals, universities, or private companies. These programs can be scheduled for the interns as appropriate during their rotations.

Project: Interns will complete individual or group research project and prepare it for publication or presentation.

Fees and Expenses: These include MSU Graduate School application fee, MSU DI application fee, tuition, and other required fees (resident, non-resident), textbooks and supplies, campus parking permit, housing, travel, meals, A.N.D. student membership, health insurance, professional liability insurance, vehicle insurance, and state and professional meeting attendance fees.

Financial Aid: Various forms of financial aid such as loans and/or part-time employment are available for dietetic interns. Federal Aid Programs are based on need as determined by the federally mandated needs analysis. Information on eligibility rules and application guidelines can be found in the MSU Bulletin or prospective students may contact: Department of Student Financial Aid and Scholarship, Box 6035, Mississippi State, MS 39762, 662-325-2450 or 662-325-3990, http://www.sfa.msstate.edu/. Awards may also be available through A.N.D., professional and honorary fraternities, and foundations.

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Estimated Expenses for MSU Dietetic Internship Program1

Fees and Expenses MSU Dietetic Internship Program Application Fee, Graduate School application fee, DICAS, D&D matching $200.00

Tuition2 http://www.controller.msstate.edu/accountservices/tuition/

Summer Resident (3 hours) $1,384.682

Summer Non-Resident (3 hours) $3,724.682

Resident (9 hours) per semester $4,325.002

Non-Resident (9 hours) per semester $11,625.002

Other Fees and Expenses2

Internship Fee $2,500.005

MSU Campus Parking Permit $150.002

Estimated cost for textbooks (Appendix), supplies (scrubs, etc.) $500.00

ServSafe Training $175.00

Student Health Insurance3 $1,201.00

Professional Liability Insurance4 $24.00

Physical Exam $75.00-$250.00

Living Expenses (housing, food, etc.) Amount varies

Interns provide their own living arrangements

Professional Membership/Meetings

A.N.D. Student Membership $60.00

Professional Meetings: FNCE (required), Mississippi Dietetic Association Annual Meeting (required,)) and Northeast District Dietetic Association Meetings (required) Attendance at a Review Course for the Registration Examination

Meeting expenses will be paid from internship fees

Transportation Amount varies

Interns must provide own transportation between the university and facilities and must carry sufficient automobile insurance coverage for collision and liability. Carpooling with other interns in the same rotation is encouraged.

1Interns may not schedule additional responsibilities such as assistantships and full-time jobs as they will be working in assigned facilities Monday–Thursday and will have DI class on Friday mornings. Interns will take one graduate class each semester and summer (must take Advanced Clinical Nutrition in summer) in addition to FNH 8286 Supervised Practice Experience.2These costs are estimated as average cost, based on the best available information and subject to change or personal difference or needs. Total shown includes tuition, activity fees and do not include course participation fees, special fees, or overload tuition. Additional information is available in the Graduate Bulletin at http://www.grad.msstate.edu/ and at http://www.controller.msstate.edu/accountservices/tuition/ (Prices will increase yearly and may not be correct as of this printing)3This insurance is sponsored through the MSU Student Association. It is a voluntary plan for students and their dependents. Prices may change. Information on student health services and student health insurance is available at www.health.msstate.edu or http://www.health.msstate.edu/healthcenter/insurance_student.php or by calling (662) 325-5895. 4Professional liability insurance is required for Dietetic Interns. One choice for insurance is Marsh U.S. Consumer. Information and registration for this insurance can be found at www.proliability.com. There are 2 options for coverage: 2,000,000 per incident for $24/year and 1,000,000 per incident for $20/year. 5Portion of this fee will be utilized to pay for educational opportunities, materials and travel necessary to complete the training competencies of the Dietetic Internship Program.

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Policies and Procedures Students and faculty at MSU are subject to the operating policies and procedures found at http://www.msstate.edu/dept/audit/mainindex.html and in the MSU Bulletin at http://catalog.msstate.edu/

Withdrawal from the University: Any student leaving the University prior to the end of the period of enrollment, except for temporary absences, must initiate withdrawal procedures in the Office of the Graduate School. By completing this procedure, the student will prevent future difficulties in obtaining transcripts, or in reentering the University, and will avoid having F's automatically recorded for all courses taken during the semester. No withdrawals will be allowed during the last two weeks before the beginning of final examinations for the fall and spring semesters and during the last week prior to the beginning of examinations for each five week/ten week summer term. The withdrawal of any student shall not be effective on a date prior to the actual date of withdrawal except in cases of serious illness or extreme hardship, and then only upon recommendation of the student's academic Dean. If the effective date of withdrawal and the actual date on which the withdrawal occurs are separated by more than one calendar year, the Provost must approve the withdrawal recommendation of the academic Dean. Students dropping the only course in which they are enrolled must process a withdrawal from the University rather than processing a schedule change.

Withdrawal from an Individual Course: Individual courses may be dropped without a grade from a student's schedule through the fifth (5th) regular university class day. Individual courses may be dropped with a grade of "W" from the sixth (6th) through the thirtieth (30th) regular university class day by processing a schedule change form. See the Academic Calendar in the front of the Graduate Bulletin for specific dates, or the website (http://www.grad.msstate.edu/academic_calendar/). Students dropping the only course in which they are enrolled must process a withdrawal from the University rather than processing a schedule change. Specific information is at http://www.msstate.edu/dept/audit/1201.html and http://www.msstate.edu/dept/audit/1202.html

Refunds of Tuition and Fees: Students who reduce their course load during a semester to a level which results in a reduction in tuition and fees may receive a 100% refund for the courses dropped until the 10th day of classes. This does not apply to overload courses. After the 10th class day, no refunds are made for individual courses dropped.

Insurance Requirements, including those for professional liability: Health and professional liability insurance are required for interns in the MSU DI. Interns may obtain health insurance through the MSU Student Health Center and professional liability insurance through Marsh at www.proliability.com or other insurance company. Estimated cost for liability insurance and the MSU sponsored health insurance program are listed under Fees and Expenses. Interns who can show proof of independent health insurance coverage may choose not to enlist in MSU's health plan.

Special Needs: It is the responsibility of any student who has special needs (section 504 of the Rehabilitation Act and the American Disabilities Act) to inform the DI Director as soon as possible so reasonable accommodations may be provided. The student must self-identify concerning disabilities documentation that is as recent as within the last three years and request necessary accommodations.

MSU Honor Code: MSU is dedicated to the discovery, development, communication and application of knowledge in a wide range of academic and professional fields. The MSU Honor Code is critical to

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these ideals, to the goal of assuming a place of preeminence in higher education, and to the development of the whole student. The MSU DI promotes academic integrity and enforces the MSU Honor Code. The MSU Honor Code states “As a Mississippi State University student I will conduct myself with honor and integrity at all times. I will not lie, cheat, or steal, nor will I accept the actions of those who do.” Access the MSU Honor Code at http://www.honorcode.msstate.edu/policy/.

Statement of Equal Opportunity: Mississippi State University does not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or veteran status.

Protection of Private Information/Access to Personal Files: The University recognizes that the maintenance of student information and educational records is necessary and vital to assist the student’s education and development and to provide opportunities for University research and policy formation. The University recognizes its obligation to exercise discretion in recording and disseminating information about students to ensure that their rights of privacy are maintained.

The University will furnish annual notification to students of their right to inspect and review their education records; and the right to request amendment of educational records considered by them to be inaccurate or misleading or that violates privacy or other rights; and of their right to a hearing should the University decline to amend such records. This annual notice will be published in the University’s Bulletin. The University utilizes the Guide for Retention and Disposal of Records as published by the American Association of Collegiate Registrars and Admissions Officers as the policy for disposal of students’ records.

The following guidelines have been developed to insure the privacy rights of students. For the purposes of this policy statement, a student is defined as an individual who has been admitted and has been in attendance in a component unit of the University. Classification as a student in one component unit of the University (e.g. undergraduate program) does not infer that the person has been accorded the rights outlined below in other components units (i.e. graduate school, professional schools, branch campus).

Students have the right to be provided a list of the type of educational records maintained by the University which are directly related to the student; the right to inspect and review the contents of these records; the right to obtain copies of these records; the right to a response from the University to reasonable requests for explanation and interpretation of these records; the right to an opportunity for a hearing to challenge the content of these records; and if any materials or document in the educational record of the student includes information on more than one student, the right to inspect and review only the part of such material or document as relates to the student.

Students do not have access to: financial records of their parents; confidential letters and statements of recommendation which have been placed in the educational record prior to January 1, 1975, provided such letters of statements were solicited or designated as confidential and are not used for purposes other than those for which they were specifically intended; confidential recommendations, if the student signed a waiver of the right to access, respecting admission, application for employment, and the receipt of an honor or honorary recognition.

Students do not have access to: instructional, supervisory, and administrative personnel records which are not accessible or revealed to any other individual except substitute Campus Security records, which

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are maintained apart from the educational records, are used solely for law enforcement purposes and are not disclosed to individuals other than law enforcement officials of the same jurisdiction; employment records except when such employment requires that the person be a student; and the Alumni Office records.

Students do not have access to physical or mental health records created by a physician, psychiatrist, psychologist or other recognized professional acting in his or her capacity, or to records created in connection with the treatment of students under these conditions which are not disclosed to anyone other than the individuals providing treatment. A physician or appropriate professional of the student’s choice may review these records.

Students should contact the appropriate office to inspect and review their records. An office may require that a University official be present when a student inspects and reviews his educational records. Any questions concerning a student’s access to records should be directed to the Registrar.

Release of Directory Information: The University without the student’s written consent may release directory information. Directory information consists of all items listed on the student’s enrollment form except social security number, PINS, and test scores. Participation in recognized activities and sports, weight and height of members of athletic teams, dates of attendance, degrees and awards received, the most recent previous educational agency or institution attended, and other similar information is considered directory information.

A student may deny the release of directory information by requesting that the information not be released. This should be done at registration time. The student who is in attendance must notify the Registrar’s Office in writing each semester of enrollment to deny the release of this information. To deny release of participation in recognized activities the student must notify the Provost and the Academic Dean in writing. To deny the release of athletic information, the student must notify the Director of Athletics in writing. To deny the release of directory information, a student must give the above notification each semester of registration. A former student, one who is not in attendance, must contact the appropriate offices to deny the release of directory information.

Student Directory information will be made available to private businesses, religious organizations, and other non-university organizations in the following manner: (1) the campus Directory is believed to be accurate (some students may have requested their names not be listed), (2) the University is not responsible for inaccuracies in the information, (3) a list of computer labels will not be available to any non-university group, and (4) appeals will be handled by a subcommittee composed of the Registrar, student member, and Dean of Student Services.

Release of Educational Records: The University will release a student’s education record(s) upon the student’s written request. The student must: (1) specify the records to be disclosed, (2) include purpose(s) of the disclosure, and (3) state the party or parties and the address to which the information is to be disclosed. The student shall, upon request, receive a copy of the record that is to be disclosed. It is University policy to furnish single copies of a student’s record at no charge except for the standard transcript fee, if applicable.

The University may release students’ educational records to the following without prior written consent:

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1. University officials who have a legitimate educational interest in the records. University officials are defined as teachers, administrative personnel and other employees except personnel of the security or law enforcement unit of MSU who in the performance of the duties require access to student records. If University officials are required in the performance of their duties to review the educational records of a student, this will be considered to be a legitimate educational interest.

2. Officials of another school in which the student intends to enroll upon request of the transfer school.

3. Government representatives of the Comptroller General of the United States, the Secretary of Education, the U.S. Commissioner of Education, the Director of the National Institute of Education, the Assistant Secretary for Education, State educational authorities, and State officials to whom such information is specifically required to be reported or disclosed by State law adopted prior to November 19, 1974.

4. Appropriate authorities in connection with financial aid with the understanding that only the necessary records will be released.

5. To organizations conducting studies for, or on behalf of the University or its agencies for the purpose of developing, validating, or administering predictive tests, administering student aid programs, and improving instruction and student life provided that the studies will not permit the personal identification of students and their parents by individuals other than representatives of the organization and provided that the personally identifiable information, furnished will be destroyed when no longer needed for the purposes for which the study was conducted.

6. To accrediting organizations to carry out accrediting functions. 7. To parents of a dependent student as defined in section 152 of the Internal Revenue code of

1954. University officials may release educational records to parents on the basis of written certification from the parent that the student is a dependent as defined under the Code.

8. To comply with a judicial order or lawfully issued subpoena with the understanding that the student will be notified in advance insofar as possible.

9. To appropriate parties to protect the health and safety of the student or other individuals in emergencies with the understanding that only information essential to the emergency situation will be released, that information will only be released to a party who would be in a position to deal with the emergency, and that the student will be notified insofar as possible of the information released, the purpose for the release, and to whom the information was released.

No personal information on a student will be released without a statement from the University to the party receiving the information that no third party is to have access to such information without the written consent of the student.

This policy is adopted pursuant to the Family Educational Rights and Privacy Act of 1974, as amended (20U.S.C.#8 1232g) and is not intended to impose any restrictions or grant any right not specifically required by this Act.

Professional Behavior: Professional behavior must be adhered to throughout the DI program. Professional, ethical conduct is expected at all times. Students are guests of the site.

Site preceptors volunteer their time to contribute to and further the profession of dietetics, and they deserve the utmost respect. Remember that your placement is a privilege, not a right.

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A professional attitude must be conveyed to the site coordinators/preceptors, supervisors, all other site personnel, patients/clients, students, faculty, and the DI director. Dietetic interns are required to adhere to all confidentiality policies in place at their assigned sites. HIPPA guidelines must be followed at all sites.

Students should portray a positive professional demeanor when at assigned sites. It is not acceptable for students to complain about workload or any other issues related to their internship program or professors while at their sites and while attending class. Concerns about the problem should be addressed privately with the DI director.

Dietetic Interns are participating in a supervised practice site for educational purposes. Dietetic Interns should not be used to replace employees. Interns will be asked to assist employees or demonstrate competency in an area by completing a task or working in a station (for example) but should not be used to replace employees. The DI director should be contacted if questions arise regarding this policy.

Professional Appearance: The dietetic intern represents the MSU DI program, the facility in which each rotation takes place, and the dietetics profession. Your personal appearance communicates a message to patients, their family members, preceptors, colleagues, and other health care providers that you are a professional. It is your responsibility to be neat, clean and appropriately dressed during your rotations and when attending professional meetings or engaged in other activities that are part of the program requirements. You are expected to conform to each rotation site’s dress code policy (See MSU DI Dress Code Policy in the Appendix).

Liability for Safety in Travel to or from Assigned Areas: Interns will be required to provide their own transportation to facilities. Automobile insurance (liability) in the state of Mississippi is mandatory. MSU and the MSU DI program assume no liability.

Inclement Weather: In the event of, or when, there is the possibility of bad weather conditions, it is the intern’s responsibility to be in contact with the site coordinator/preceptor and DI director. Weather conditions are difficult to predict and may vary from location to location. Do not assume you are not to report to a site if the schools in that county are closed or if MSU is closed. Call the local Mississippi Highway Patrol office to evaluate travel conditions to the various sites.

Physical Exam/Immunization/Health Record: To meet state and federal health code requirements, all students are required to have a physical examination, proof of immunity to Measles and Rubella, and tuberculin testing within the past 6 months prior to commencing the Supervised Practice Experience. Students must provide a completed immunization record (Appendix), which includes record of MMR and Rubella titer, history of chicken pox or varicella titer, and Hepatitis B vaccine series. Some sites may also require a flu vaccine. Interns are responsible for all financial obligations incurred with these requirements.

Exposure to Infectious Diseases: During your rotations it is possible that you may be exposed to an infectious disease. In the event you are exposed, you are required to follow the standard operating procedure for that facility.

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Injury and/or Illness: Should any intern become ill or sustain any injury while at the facility, expedient emergency care shall be obtained. Interns are responsible for financial/medical insurance to cover such emergencies and follow-up care as needed. Interns must immediately notify the DI director (contact information is in the Appendix) of medical or nonmedical emergencies and the preceptor or site coordinator if they are going to miss a rotation due to injury, illness, or extenuating circumstances. It is the intern’s responsibility to make up any missed work/time from a rotation at the convenience of the preceptor and site coordinator. This includes leaving early, arriving late, etc., during a scheduled day at any facility. Interns are responsible for rescheduling any missed planned experiences with the site coordinator.

Drug Testing and Criminal Background Checks: Random drug testing and criminal background checks may occur if required by the supervised practice facilities.

Attendance Policy: Interns must notify immediately their site coordinator and/or preceptor if they are going to miss a rotation due to illness or other extenuating circumstances. The Program Director must also be notified of absences when they occur. The Program Director may be reached at 662-325-3200 ext. 5902 and voice mail is available when the Director is not available. Interns are responsible for rescheduling missed work/time at the convenience of site coordinator/preceptor. All absences and reason for absences must be noted on the intern evaluation form. All assignments and projects must be completed by the given deadlines. The meeting of deadlines is a significant factor in all evaluations. Extended absences may require that the intern withdraw from the program.

Leave of Absence: It is the policy of the MSU DI to allow an intern to take a leave of absence for up to one year. Any intern who has completed at least one month of supervised practice may request a leave of absence. Interns who request a leave of absence who have completed less than one month of supervised practice time may be granted their leave of absence or may be asked to delay their program until the following program year depending on the length of time the absence is required.

If an intern requests a leave of absence from the DI, they must alert the DI director immediately and provide a letter requesting the leave of absence. Interns who do not report to their assigned supervised practice rotation without pre-approval from the DI director may be removed from the program without the ability to return.

Any intern granted a leave of absence will be required to restart the program on the agreed date. Any intern taking a leave of absence will still be eligible for program completion, but this will occur only after all program requirements have been met.

Examples of reasons that may require a leave of absence are medical conditions undergoing treatment, death of an immediate family member, or pregnancy. The DI director will review any intern request individually. The DI director reserves the right to either grant or refuse delay of program entry to any appointed intern. It is the policy of the MSU DI to work with each situation individually and try to establish a schedule change which accommodates the site coordinators and the intern.

Vacation, Holidays, and Absences: During the supervised practice experience, vacation time is not granted. The interns will observe holidays as scheduled by the site coordinator or preceptors. Overtime, work on weekends and during holidays is a possibility at some facilities.

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Cell Phones, etc.: Use of a cell phone, text messaging devices, iPods or other electronic devices is prohibited while interns are working at his/her supervised practice site. They are also not allowed in class at MSU. Individual preceptors may allow respectful use of electronic devices for work-related issues only, such as researching drug interaction information or nutrient database information, etc. The intern should obtain approval from the preceptor before using any electronic device at a supervised practice location. Failure to act professionally with regards to this policy may lead to dismissal from the DI program.

University Academic Calendar is available at https://www.msstate.edu/calendars/

Grievances Grievances against MSU faculty will follow the procedures outlined in the MSU Handbook and Graduate Bulletin. The DI program director is responsible for receiving and handling complaints from interns, faculty, preceptors, and others directly involved with the program. If intern(s) have a grievance against a preceptor or the content or process of a rotation, the following procedure will be followed:

PROCEDURE The first step in resolution of a legitimate intern grievance is to attempt to resolve the issue with the faculty and/or facility preceptor with whom the grievance originated. If agreement is not reached, the intern may present an appeal to the MSU DI Director. In the event that the grievance is still not resolved to the intern's satisfaction, the line of authority is the Department Head of Food Science, Nutrition, and Health Promotion, the Dean of the College of Agriculture and Life Sciences, the MSU Provost, and the President of the University. If the intern fears retaliation from the faculty member, preceptor, or DI Director, he/she may directly report complaints to the Head of the Department of Food Science, Nutrition, and Health Promotion. The DI Director maintains communications related to grievances and works with the appropriate individual(s) to resolve the issue. A grievance file is maintained in the DI Director’s office, with documentation of the final outcome. ACEND will review complaints that relate to a program's compliance with the accreditation/approval standards. ACEND is interested in the sustained quality and continued improvement of dietetic education programs but does not intervene on behalf of individuals or act as a court of appeal for individuals in matters of admissions, appointment, promotion or dismissal of faculty, staff, or students/interns.

A copy of the accreditation/approval standards and/or the Council’s policy and procedure for submission of complaints may be obtained by contacting the Accreditation Council for Education in Nutrition and Dietetics (ACEND), 120 South Riverside Plaza, Suite 2000, Chicago, IL, 60606-6995 or calling 312/899-0040 extension 5400.

Disciplinary Process/Termination: Interns must abide by policies and procedures of facilities while completing their planned experiences. Failure to comply with stated policies and procedures would compel the site coordinator at the facility to issue a Warning Notice to the intern. The facility site coordinator will document on facility letterhead, any incidence whereby an intern fails to comply with the policies and procedures of the facility while completing their planned experiences. The DI program director will receive a copy of the Warning Notice for the intern's file and meet with the intern to discuss the Warning Notice. After receipt of three warning notices, the intern may be asked to leave the DI program. The purpose of the Warning Notice is to provide documentation of an incident which may lead to an intern's termination from the DI program.

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An intern may also be terminated from the program if their work is deemed unsatisfactory. Interns receive evaluations following each of the rotations from the preceptor or site coordinator. Each intern is accountable for obtaining his or her evaluation. Copies are maintained in the intern's file. If part of a rotation is not acceptable (receiving numerous “1” or “2” scores, particularly after December), the intern is responsible for arranging with the preceptor a strategy to make up the planned experience. Failure to complete any of the required planned experiences prohibits interns from receiving their Verification Statement of Completion of the DI and may lead to termination from the DI program.

Evaluation

Written Assignments: All written assignments will be reviewed by the preceptor prior to the completion of the rotation. The preceptor may require revision as he/she deems necessary. When an assignment has been completed to the preceptor’s satisfaction, the assignment will be placed in an intern folder and the date of completion will be indicated on the rotation's checklist. At the end of the rotation, the facility will send all assignments and the checklist to the DI director for review. All assignments are graded as acceptable, marginal, or not acceptable. If the student assignment is marginal or not acceptable, he/she will be given one chance to rework the assignment.

Student Performance and Practice Evaluation: Interns will be evaluated by preceptors using a Clinical Nutrition Evaluation form, a Food Service Management Evaluation form, or a Community Nutrition Evaluation form (Appendix). Each evaluation is based on a 5-point scale:

5 Outstanding Always applies self and integrates materials, applies concepts, completes excellent work

4 More than satisfactory Applies self, usually integrates materials and/or applies concepts, completes good work

3 Satisfactory Completes satisfactory work, applies self, knows the required concepts and materials

2 Minimally adequate Applies self to the minimum that is required to complete tasks

1 Needs improvement Unprepared and/or unable to understand basic materials

An intern must receive a 3 or better to be considered competent in that area. Should an intern score less than a 3, a conference will be held with the intern, the preceptor and the DI director. A plan and identified timeline will be developed for remediation in the matter. Should the intern not score a 3 or better in the approved timeline, the intern may be subject to dismissal, pending review of the reasons for poor performance and the intern’s inability to complete the remedial actions. The review will include the DI director, site coordinator and the intern.

In addition to evaluations, interns can be given a formal warning for inappropriate behavior. Examples of inappropriate behavior include complaint by the preceptor or site coordinator of chronic tardiness and/or missed work, insubordination to faculty, preceptors, or site coordinators, and theft. If an intern receives a total of three warnings from at least two different facilities, the intern may be asked to leave the DI.

Forms: Evaluation forms (Clinical, Food Service Management, Community Nutrition, and Intern 20

Rotation Evaluation) will be provided and are included in the Appendix.

Procedure for Evaluation at Each Site: The following procedure/order will be followed when evaluating student performance and evaluating the rotation/experience at each site:

• Interns will turn in completed Intern Rotation Evaluation form of the site/rotation in a sealed/ signed/dated (across flap on back) envelope to the site coordinator and/or preceptor (or DI director if preceptor prefers)

• Site coordinator and/or preceptor will discuss the intern’s evaluation (Clinical, Food Service Management, or Community Nutrition) for the site/rotation

• The intern will turn in their Evaluations (Clinical, Food Service Management, or Community) to the DI Director as soon as the rotation is complete.

Procedure for Competency Checklist at Each Site: Each site has a set of competency checklists. Each checklist contains all of the competencies/learning outcomes you are expected to accomplish at that site. You are to complete all of the competencies set by the 2017 Accreditation Standards by the end of your supervised practice experience. You will most likely repeat some competencies. This will contribute to your proficiency level and is to be expected. Please remember that what is planned is not always what happens. Planning is important but being flexible is just as important. Instructions for completing the Intern Competency Checklist for each site are included in the Appendix. It is the intern’s responsibility to provide the checklist for each site and to make sure the preceptor initials each competency. All checklists must be returned to the DI director as soon as the rotation is completed.

Prior Learning: All interns will be assessed for prior learning and given up to 300 supervised practice hours for the prior learning. The prior learning will be assessed by the Director as follows:

• Graduate Assistantships (GAs) Any intern that has a GA will be given supervised practice hours based on the hours worked in their GA and the type of work they are doing. They will be given credit for ACEND competencies based on their GA. The GA must keep a record of hours worked and date and exact competencies they met (providing proof with the GA preceptors’’ signature).

• Previous Work Experience Interns must provide a resume and portfolio that contains the learning activities completed in their previous work experience. Credit for competencies met, will be given to the intern based on their resume, portfolio and employment history.

• Prior learning hours will be given on a 1 to 1 ratio.

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Tips for Success during Supervised Practice

Progressive Steps Through Supervised Practice Do Don’t Self-Assessment: 1. Analyze your interests, values & goals & be certain your 1. Do not act as if you know all the answers. Acceptance of Placement faculty advisor is fully aware of them.

2. Despite temporary placement & student status, regard yourself as a professional & a member of the staff.

3. Prepare yourself to expect & accept that problems & frustrations will occur.

4. When problems occur, be patient & pleasant; cope with problems with an attitude toward solution & negotiation.

Remember, as a student, you are placed in the agency for a learning experience.

2. Do not let yourself become involved in internal conflicts

Routine Office Matters 1. Be sure to find out where you are to work—office, desk space, chair, telephone, etc. so you know your operational base.

2. Be aware of office practices regarding dress, protocol, office hours and flexibility, holidays. Follow rules set for regular staff.

1. Do not expect any special treatment.

Orientation 1. Request & read information you need regarding the organizational structure, names of key people, office policies & procedures to facilitate your orientation.

2. Determine what information you may need which has already been compiled. Find out who is knowledgeable in your own office and others.

3. Become familiar with the entire agency so you can see where you fit. Review: a. Annual reports, program plans, program

descriptions, etc. b. Budget documents c. Organization charts

1. Do not take too long to familiarize yourself with the agency, staff, etc.

2. Do not let yourself “take sides” in office politics.

3. Do not be critical of the nutrition staff if documents & plans do not follow the format learned in school. The format & procedures for such documents as plans, budgets, etc. are usually dictated by the agency or a higher governmental entity.

Integrating into the New 1. Initially, learn to fit in by being formal toward everyone. 1. Do not become so assertive as to threaten Environment Then gradually, depending upon the climate, establish

friendships or at least pleasant working relationships with other employees.

2. Quickly learn the people who facilitate the work-flow. 3. Attempt to gain an appreciation for the clerical and

secondary functions of the agency, for they are the building blocks of the primary mission. A finished project can be delayed, altered, or expedited depending upon the inclination of the clerical staff!

4. Develop a list of persons to know in your working environment so when you need to contact them, you have their phone numbers. You may want to include other information, e.g., the context of your meeting, the date, the person’s position, etc.

5. In order to become involved with the process of management, make an effort to attend meetings, be included on reading lists, and in other day-to-day management activities.

6. Record events that occur to assist with preparation of your documentation for the competencies (keep a daily journal of what you are doing and learning).

other employees; however, appear competent enough to establish a basis for receiving favorable recommendations.

2. Do not exercise authority. However, do be ready to offer suggestions.

3. Do not become “pigeon-holed” but attempt to expand your knowledge by contacting program managers in other divisions to gain insight into the organization as a whole. Contacting managers in other agency units or other agencies should always be coordinated through your preceptor.

Establishing the Task(s) & 1. Establish the expectations, limitations, and directions of 1. Do not hesitate to contact the internship Assignments the competencies with your preceptor at the beginning of

your rotation. 2. Evaluate your assignments in terms of the amount of time

available during your rotation. 3. If occasionally asked to perform routine work, remain

pleasant and complete the tasks. However, if a majority of your assignments constitute busywork, speak with your preceptor. If necessary, inform the Dietetic Internship Program director and ask for assistance.

4. Plan carefully around the time available to you so time limitations will not be a problem. Draw a time line so you and your supervisor will be able to realize the time required for an assignment.

director if the experiences are not in line with the competencies.

2. If you feel a task is irrelevant, do not accept the task without asking questions about its relevance. However, do not ask questions in such a way as to be offensive.

3. Do not allow yourself to be overloaded with tasks no other staff member will do.

4. Once you have learned a procedure or task, do not be tempted to repeat it. Your mission is to move on and gain as much varied experience as possible.

5. Do not pretend you performed a certain type of task when, in fact, you have not; do not

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refrain from asking questions until you understand the task at hand.

6. If you leave an unfinished product, do not leave it in such a condition that no one else would be able to continue working with it.

Developing Student/Preceptor Rapport

1. Establish a good working relationship so you will be able to talk freely about what you are receiving or lacking from the experience.

2. Assure your preceptor you have a desire to learn and you are putting forth all efforts to make the experience worthwhile.

3. If you suffer from “lack of guidance”, remedy the situation by either approaching your preceptor or dietetic internship director. However, it is necessary to respect the preceptor’s extensive responsibilities and to be as understanding of his/her work schedule as he/she is of yours.

4. You should be innovative and not expect constant supervision. Be positive and demonstrate initiative.

5. With respect to your preceptor, remember he/she is responsible for your relations with other sections & departments. Make contacts pleasant, productive, and quick—not wanting to be the cause of any negative feelings between you and others.

1. Do not fail to have regularly-scheduled meetings with your site coordinators, preceptors, and/or DI director so you can acquire feedback.

Vital Elements of Successful Experience

1. Do make the most of your situation. Gain as much experience and knowledge as possible, and at the same time make a meaningful contribution to the agency or facility.

2. Follow through on whatever job you undertake; deadlines are important and should be strictly adhered to.

3. As a student, be aware that educational training is an important tool to be used in the working world. Classroom theories are helpful, but there are exceptions and situations that require flexibility and experience when putting book learning to work in the “real world.”

4. Develop and maintain careful, quality work habits. 5. Since staff may be busy, schedule meetings with

individuals several days in advance. 6. Take advantage of training workshops offered inside and

outside of the organization. 7. Keep a positive attitude and remember that new ideas

take a long time to implement.

1. Do not become discouraged when your prepared reports go through a refining process when reviewed by staff. Remember, they are the experts and know what will get the job done. Your job is to gain experience and knowledge while keeping an open mind.

2. Do not refrain from contributing. 3. Do not be defensive when you make

mistakes. Mark it off as par for the course and continue on. Remember you are there to develop your talents and skills.

4. Do not allow yourself to become involved in issues which came to friction before you came on board, nor become involved in office politics (be an impartial observer).

Future Direction 1. Be aware of the possibility you may discover a change in your career objectives based upon your experiences.

1. Do not expect to be an expert upon completion of your supervised experiences. But do realize you will be “practice-ready” as an entry level dietitian.

Adapted from Koehler, Cortus T.: The Intern and the Internship from Beginning to End, Teaching Pol. Sci., pp. 329-335, April 1980.

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CONTACT INFORMATION FOR THE MSU DI DIRECTOR

Dr. Terezie T. Mosby Department of Food Science, Nutrition & Health Promotion 206 Herzer Building on Stone Blvd. Mississippi State University – Starkville Campus terezie.mosby@msstate.edu Office phone: 662-325-5902 Department phone: 662-325-3200 FAX: 662-325-8728 Dietetic interns are provided with Dr. Mosby’s cell phone number

Mailing address: Dr. Terezie Mosby Box 9805 945 Stone Blvd, Herzer Building Mississippi State, MS 39762

FACILITIES

BAPTIST MEMORIAL HOSPITAL-GOLDEN TRIANGLE

COORDINATORS: Jaqlene Villalpando, MS, RD, LD jaqlene.villalpando@bmhcc.org Clinical Nutrition Manager

MAILING ADDRESS: Baptist Memorial Hospital-Golden Triangle 2520 5th Street, North Columbus, MS 39703

PHONE NUMBERS: Clinical Office 662-244-1530 FAX 662-244-2530 Ms. Jaqlene Villalpando 662-803-7476 (cell phone) Ms. Carley Markham 662-244-1597 (office)

DIRECTIONS TO FACILITY FROM STARKVILLE: Go east out of Starkville on Highway 82 bypass to Columbus. In Columbus, get off on the 18th Street exit and follow the signs pointing to the hospital.

PARKING: Park in public parking areas the first day of the experience. For the major part of the experience you will park in the employee parking area.

EMERGENCY PHONE NUMBER/PAGER FOR SITE COORDINATORS/PRECEPTORS: Ms. Jaqlene Villalpando 662-803-7476

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FRESENIUS MEDICAL CARE WEST POINT

COORDINATOR: Carrol Ball, MS, RD, LD Carol.Ball@fmc-na.com

MAILING ADDRESS: 1612 West Church Hill Road West Point, MS 39773

PHONE NUMBER: 662-494-1530 (center phone)

DIRECTIONS TO FACILITY FROM STARKVILLE: Go east out of Starkville on Highway 82 bypass to Tupelo, Highway 45. In West Point, get off on the Highway 45, turn left on W Church fill Rd, and follow the signs pointing to the hospital.

FRESENIUS MEDICAL CARE GOLDERN TRIANGLE

COORDINATOR: Alice Watson, RD LD alice.watson@fmc-na.com

MAILING ADDRESS: Fresenius Medical Care Golden Triangle 92 Brookmoore Drive Columbus, MS 39705

PHONE NUMBER: 662-327-9200 (office)

DIRECTIONS TO FACILITY FROM STARKVILLE: Go east out of Starkville on Highway 82 bypass to Columbus. In Columbus, get off on the 18th Street exit and follow the signs pointing to the hospital. Take the first road on the right (Brookmore Drive) and the dialysis center is on the right.

FRESENIUS MEDICAL CARE STARKVILLE

COORDINATOR: Christy Henley, RD LD christy.henley@fmc-na.com

MAILING ADDRESS: Fresenius Medical Care Starkville 111 Eudora Welty Drive Starkville, Mississippi 39759

PHONE NUMBER; (662) 615-9493 (Office)

DIRECTIONS TO FACILITY FROM STARKVILLE: Go west via MS-12 and turn right onto Stark Rd. Then turn left onto Abernathy Rd and go straight till Eudora Welty, then turn right.

MISSISSIPPI STATE DEPARTMENT OF HEALTH

COORDINATOR: Kayla McMinn Kayla.mcminn@msdh.ms.gov

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Nutritionist Supervisor

MAILING ADDRESS: MS State Department of Health, District IV P.O. Box 1487 (Lynn Lane), Starkville, MS 39760

PHONE NUMBERS: 662-323-7313, District Office, Starkville 662-324-1011 FAX 662-494-4514 Clay County Health Department, West Point 662-328-6091 Lowndes County Health Department, Columbus

DIRECTIONS TO FACILITY FROM STARKVILLE: To Clay County Health Department (West Point, MS): Highway 82 East, exit on 45 Alternate North (West Point, Tupelo). Following this into West Point, go to 2nd traffic light, turn right on Broad Street, cross the railroad tracks, go to first red light, turn left on North/South Division, go one block. The Health Department is the cream color brick building on the right.

To Lowndes County Health Department (Columbus, MS): Highway 82 East, take 18th Avenue exit, turn right, go to the 2nd traffic light, turn right onto Military Road. Follow this road until you see the fire station on the left side of the road. The Health Department will be the 2nd building on the left from the fire station.

To Monroe County Health Department (Aberdeen, MS): Follow Hwy 82 E to Hwy 45 N. Continue Hwy 45 N through West Point to Hwy 25 toward Aberdeen. In Aberdeen go through two traffic lights and turn left on the next street after the second traffic light. The Health Department will be on the left side of this road.

To Monroe County Health Department (Amory, MS): Follow Hwy 82 E to Hwy 45 N. Follow 45 N through West Point to Hwy 25 toward Aberdeen. Follow the signs on Hwy 25 to Amory. Just inside the city limits of Amory you will pass a Ford Dealership on the left side of the hwy. The Health Department will be past the Dealership on the left side of the road and across for Dowdle Gas Company.

PARKING: Parking is available anywhere, except for the handicap areas. EMERGENCY PHONE NUMBER/PAGER FOR COORDINATOR/PRECEPTORS: Emergency Only: Kayla McMinn 662-323-7313, District Office, Starkville

MISSISSIPPI STATE UNIVERSITY EXTENSION SERVICE

COORDINATORS: Brent Fountain, PhD, RD, CSSD, LD, FAND Associate Extension Professor

David Buys, PhD Asst Extension/Research Prof

MAILING ADDRESS: Extension Specialists MSU Extension Service Box 9805

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107 Herzer, Stone Blvd Mississippi State, MS 39762-9805

CONTACT INFORMATION: Dr. Brent Fountain 662-325-3742 662-325-4039 FAX BFountain@provost.msstate.edu

Dr. David Buys 662-325-3060 662-325-8728 FAX david.buys@msstate.edu

DIRECTIONS TO MISSISSIPPI STATE UNIVERSITY EXTENSION SERVICE FROM STARKVILLE: Located on MSU Campus – 202D (Fountain), 202B (Buys) Ballew Hall Building on Stone Blvd.

PARKING: Use University student parking with current valid parking decal. Or contact MSU Police Department – Parking Services (325-2665) and request $1.00 shuttle pass and a map of where to park and shuttle schedule.

EMERGENCY PHONE NUMBER/PAGER FOR COORDINATOR/PRECEPTORS: 662-312-5260 (Dr. Fountain’s cell)

NORTH MISSISSIPPI MEDICAL CENTER - TUPELO

COORDINATOR: Keri C. Purser, MS, RD, LD KPurser@nmhs.net Operations & Performance Improvement Manager Food & Nutrition Services

MAILING ADDRESS: NMMC Food & Nutrition Services 830 South Gloster Street Tupelo, Mississippi 38801

PHONE NUMBERS (area code 662): 377-3734 FAX 377-3018 Clinical Dietitian’s Office 377-3018 Main Unit - Tray line, Diet Office, Galley 377-3019 Main Unit - Food Court, Production 377-3760 Main Unit - Procurement 377-3525 Central Kitchen 377-4950 Women’s Health Care 377-3622 Behavioral Health 365-4135 Baldwyn Nursing Home

Contact information for the individual preceptors will be given to each intern during orientation at NMMC-Tupelo prior to beginning rotations at this site.

DIRECTIONS TO FACILITY FROM STARKVILLE: U.S. Highway 82 East to U.S. Highway 45 North to Tupelo. Exit Eason Boulevard. Turn left. Stay in the middle lane. Turn right onto Garfield Street (Garfield angles at the 2 o’clock position at the intersection of Eason Boulevard and Green Road).

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PARKING: Park in the employee parking area

EMERGENCY PHONE NUMBER FOR COORDINATOR: 601-218-4765 (cell phone)

STUDENT HEALTH CENTER MISSISSIPPI STATE UNIVERSITY

COORDINATORS: Taylor VanDyk, RDN, LD tvandyk@saffairs.msstate.edu Department of Health Promotion and Wellness

MAILING ADDRESS: Department of Health Promotion and Wellness Longest Student Health Center P.O. Box 6338 Mississippi State, MS 39762

PHONE NUMBERS: 662-325-7683 OFFICE

DIRECTIONS TO FACILITY FROM STARKVILLE: MSU Campus Longest Student Health Ctr.

PARKING: Use University student parking with current valid parking decal.

EMERGENCY PHONE NUMBERS FOR COORDINATOR:616-560-2998 (Cell)

CHOCTAW INDIAN RESERVATION/FOOD DISTRIBUTION CENTER

COORDINATOR: Dr. Connie Black Connie.Black@choctaw.org

MAILING ADDRESS: Mississippi Band of Choctaw Indians 142 Industrial Road/ P.O. Box 6010 Choctaw, Mississippi 39350

PHONE NUMBER: 601-650-1731

DIRECTIONS TO FACILITY FROM STARKVILLE: Take Highway 25 S and take last exit, then take MS-15 S toward Philadelphia, turn right onto Highway 16 W, turn right at the signs for Choctaw High School (Recreation Rd), turn right onto Industrial Rd and the Distribution Center will be on your right

PARKING: Park in the parking lot of the distribution center.

EMERGENCY PHONE NUMBER FOR COORDINATOR: 601-650-1794

STARKVILLE SCHOOL DISTRICT FOOD SERVICE

COORDNIATOR: Ginny Hill

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ghill@starkville.k12.ms.us

MAILING ADDRESS: Henderson Ward Stewart Elementary 200 Dr. Martin Luther King Jr Drive West Starkville, MS 39759

PHONE NUMBER: 662-615-0028 (Office)

DIRECTIONS TO FACILITY FROM STARKVILLE: Take Highway 182 W (Martin Luther King Jr Drive) until you reach School Street. Take a right at the light at School Street. Follow the road all the way back until you have to turn left. You will see a gate labeled Child Nutrition. Please ring the bell and you will be let in.

PARKING: Park in employee parking.

NORTH MISSISSIPPI MEDICAL CENTER (FOOD SERVICE)- WEST POINT

COORDINATOR: Cara Sanders, RD caradsanders@gmail.com

Brandy Henson, CDE bhenson@nmhs.net

MAILING ADDRESS: 835 Medical Center Drive West Point, MS 39773

PHONE NUMBER: 662-495-2340

DIRECTIONS TO FACILITY FROM STARKVILLE: Take Highway 82 E toward West Point. Exit onto US-45 ALT N toward West Point. Follow US-45 ALT N until you reach Medical Center Drive. Turn right onto Medical Center Drive. Destination will be on right.

Parking: Park in the main lot.

EMERGENCY CONTACT: 662-660-4069

MISSISSIPPI STATE UNIVERSITY- RESEARCH

COORDINATORS: Dr. Terezie Mosby terezie.mosby@msstate.edu

Nicole Reeder nr657@msstate.edu

MAILING ADDRESS: Department of Food Science, Nutrition, and Health Promotion Box 9805 945 Stone Blvd, Herzer Building

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Mississippi State, MS 39762

PHONE: 662-325-5902

DIRECTIONS TO FACILITY FROM STARKVILLE: Located on MSU Campus – 215 (Mosby). Herzer Building on Stone Boulevard.

PARKING: Use University student parking with current valid parking decal. Or contact MSU Police Department – Parking Services (325-2665) and request $1.00 shuttle pass and a map of where to park and shuttle schedule.

EMERGENCY CONTACT FOR COORDINATOR: 901-219-8364 (Dr. Mosby Mobile)

ARAMARK FOODSERVICE MISSISSIPPI STATE UNIVERSITY

COORDINATORS: Jill Hamilton, MSEd, RD, LD, ATC, LAT hamilton-jill1@aramark.com Aramark | Senior Specialist Registered Dietitian

MAILING ADDRESS: MSU Fresh Food Company 710 Bully Blvd Mississippi State, MS 39762

PHONE NUMBERS: 407-712-3901 cell phone

DIRECTIONS TO FACILITY FROM STARKVILLE: MSU Campus Dining Fresh Food Company.

PARKING: Use University student parking with current valid parking decal.

EMERGENCY PHONE NUMBERS FOR COORDINATOR: 407-712-3901 cell phone

MISSISSIPPI STATE UNIVERSITY SPORTS NUTRITION

COORDINATORS: Pamela Bartz, RD, CSSD, CSCS pbarts@athletics.msstate.edu Director of Sports Nutrition

MAILING ADDRESS: Holliman Athketic Center / Shira Fieldhouse 235 Lakeview Drive Mississippi State, MS

PHONE NUMBERS: 662-325-1935 (Office)

DIRECTIONS TO FACILITY FROM STARKVILLE: MSU Holliman Athletic Center/Shira Fieldhouse

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PARKING: Use University student parking with current valid parking decal.

EMERGENCY PHONE NUMBERS FOR COORDINATOR: 440-759-1840 (cell phone)

SCHOOL FOODSERVICE GROWING HEALTHY WAVES

COORDINATORS: Donna Loden, RD donna@loden.us

Kelsey Ioannou kelsey.ioannou@foodcorps.org

MAILING ADDRESS: 903 Fillmore Dr. Tupelo, MS 38801

PHONE NUMBERS: 662-260-8742 (Ms. Kelsey’s cell)

DIRECTIONS TO FACILITY FROM STARKVILLE: U.S. Highway 82 East to U.S. Highway 45 North to Tupelo. Exit Eason Boulevard. Continue on W Eason Blvd and take Garfield St to Fillmore Dr.

PARKING: Park in the main lot.

EMERGENCY PHONE NUMBERS FOR COORDINATOR: 662-260-8742

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Estimated Mileage and Travel Costs to Facilities

Below are estimates of round-trip mileage to the rotation sites from the MSU campus for the duration of the internship, based on estimated number of weeks at each site.

Baptist Memorial Hospital-Golden Triangle: Columbus, MS ~60 miles x 4 days/week x 8 weeks = ~1,920 miles

Fresenius Medical Care Golden Triangle: Columbus, MS ~60 miles x 4 days/week x 2 weeks = ~480 miles

Mississippi State Department of Health: sites will vary (below are some that you may travel to) ~8 miles to and from District Office and Oktibbeha County Health Department (Starkville, MS) ~36 miles to and from Clay County Health Department (West Point, MS) ~60 miles to and from Lowndes County Health Department (Columbus, MS) ~60 miles to and from Winston County Health Department (Louisville, MS) ~78 miles to and from Monroe County Health Department (Aberdeen, MS) ~100 miles to and from Monroe County Health Department (Amory, MS) This rotation is 4 days/week x 3 weeks

Mississippi State University Extension Service: MSU campus If the intern is to travel for this rotation, they will be given the option to travel with the preceptor, so no personal mileage will be accrued. This rotation is 4 days/week x 3 weeks

North Mississippi Medical Center: Tupelo, MS ~140 miles x 4 days/week x 10 weeks = ~5,600 miles (carpooling is encouraged)

Starkville School District Food Service: Starkville, MS ~6 miles x 4 days/week x 1 week = ~24 miles

North Mississippi Medical Center (Food Service): West Point, MS ~40 miles x 4 days/week x 1 week = ~160 miles (carpooling is encouraged)

Mississippi State University Student Health Center: MSU campus If the intern is to travel for this rotation, they will be given the option to travel with the preceptor, so no personal mileage will be accrued. This rotation is 4 days/week x 3 weeks

Choctaw Indian Reservation/Food Distribution Center ~130 miles x 4 days/week x 3 weeks= ~1,560 miles (carpooling is encouraged)

Mississippi State University Research: MSU Campus This rotation is 4 days/week x 1 week The total amount of possible travel will be 25 weeks x 4 days/week. The estimated amount of travel to rotation sites is 11,000 miles. Costs for mileage vary tremendously depending on price of gasoline, miles per gallon of your automobile, etc. Carpooling is encouraged.

34

Additional travel may be required to attend meetings. You are encouraged to carpool whenever possible. However, please be aware that you need to be at the site when preceptors or staff to whom you are assigned requires you to be there. Preceptors and others may not be able and do not need to change their schedules to accommodate your desire to carpool.

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APPENDIX

36

Mississippi State University Dietetic Internship BOOKLIST

Required Books:

1. Medical Dictionary of your choice or a reputable online source such as www.nlm.nih.gov/medlineplus/mplusdictionary.html

2. Medical Nutrition Therapy textbook of your choice. Recommendations: Mahan, L. K., & Raymond, J. L. (2017). Krauses food & the nutrition care process (14th ed.). St. Louis, MO: Elsevier. Nelms, Sucher, Lacy, Roth. Nutrition Therapy & Pathophysiology, 3rd edition.

3. Excott-Stump, S. Nutrition and Diagnosis-Related Care, 8th edition. ISBN 978-1-4511-9532-3173 Academy of Nutrition and Dietetics. Nutrition Care Process Terminology. eNCPT. Student subscription $25. (required) Academy of Nutrition and Dietetics. Nutrition Care Manual. https://www.nutritioncaremanual.org/sso.cfm?c=mississi

4. Online Student Subscription available through the library.

5. Academy of Nutrition and Dietetics. Pediatric Nutrition care Manual. https://www.nutritioncaremanual.org/sso.cfm?c=mississi2. available through the library

6. Pronsky, Z.M., et al. Food-Medication Interactions Handbook. 18th edition (may order at foodmedinteractions.com for $42.95 total with shipping; may be able to find cheaper on other sites). ISBN: 0-9710896-6-3

Other Useful Resources (these are not required):

1. Pennington. Food Values of Portions Commonly Used. 18th edition

2. AND Pocket Guide to Nutritional Assessment (3rd edition) ISBN: 978-0-88091-489-5

3. AND Pocket Guide to Enteral Nutrition (2nd edition) ISBN: 978-0-88091-469-7

4. AND Pocket Guide to Lipid Disorders, Hypertension, Diabetes, and Weight Management (2nd

edition) ISBN: 978-0-88091-985-2

5. Fragakis & Thomson. The Health Professional’s Guide to Popular Dietary Supplements. 3rd

edition

Useful Websites: Office of Dietary Supplements http://ODS.od.nih.gov/ Lab Tests Online www.labtestsonline.org/ USDA National Nutrient Database for Standard Reference http://www.ars.usda.gov/ba/bhnrc/ndl

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Agricultural Research Service www.ars.usda.gov/foodsearch National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/guidelines/index.htm The National Guideline Clearinghouse™ www.guideline.gov American Society for Parenteral and Enteral Nutrition (ASPEN) www.nutritioncare.org

38

MSU Dietetic Internship Dress Code Policy

The dietetic intern represents the Mississippi State University Dietetic Internship Program, the facility in which each rotation takes place, and the dietetics profession. Your personal appearance communicates a message to patients, their family members, preceptors, colleagues, and other health care providers that you are a professional. It is your responsibility to be neat, clean and appropriately dressed during your rotations and when attending professional meetings or engaged in other activities that are part of the program requirements. You are expected to conform to the dress code policy for each site. Name tags must be worn at all times. You may be given special name tags to wear at specific facilities.

Scrubs may be worn at six of the rotation sites. Listed below are the dress code requirements for each of the sites for the internship.

Baptist Memorial Hospital-Golden Triangle: black / brown scrubs and white lab coat Fresenius Medical Care Golden Triangle: any color scrubs and white lab coat Mississippi State Department of Health: black scrubs or business casual attire Mississippi State University Extension Service: business casual attire North Mississippi Health Services-Tupelo: Carnation pink scrubs or business casual attire Starkville School District Food Service: casual professional attire Choctaw Indian Reservation/Food Distribution Center: business casual attire or any color scrubs Student Health Center Mississippi State University: any color scrubs or business casual attire Aramark: casual professional attire with non-slip safety shoes Sports Nutrition: internship polo, athletic wear (Adidas preferably and Mississippi State shirts with tennis shoes

General requirements: • Clothing must fit properly and be neat and wrinkle-free. • Proper undergarments must be worn. • Shoes: shoes should completely cover feet; discretely colored tennis shoes may be worn with

scrubs. Socks should be worn with tennis shoes. • Hair should be clean and neatly controlled. Hair must be placed in a hair restraint in food

production areas. • Discrete jewelry may be worn, for example, wedding bands and small earrings. No dangling

necklaces, earrings, or bracelets are allowed. Rings with stones in food production areas are not allowed.

• Nails should be clean and short in length. Artificial nails are not allowed and nail polish is not allowed in food production areas. Nail polish should be modest in color if allowed.

• Strong fragrances should be avoided (perfume, cologne, body sprays, etc.). • Subtle cosmetics may be worn. • All visible piercings should be removed, except for ears. One earring allowed in each ear. • Tattoos should not be visible. • Beards, sideburns, and mustaches should be short and well-groomed. Beards must be covered

in food production areas.

*Scrubville in Starkville, MS is a good source for scrubs. Reasonably priced brands and styles

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include: Cherokee Uniforms (Ladies v-neck top and elastic waist pants), Urbane by Landau (Classic crossover top and boot-cut drawstring pant), and Scrub Zone by Landau (V-neck 2 pocket top and unisex drawstring pant).

**Business casual attire: a step down from professional business attire. Professional business attire is more formal and would be worn to an interview (example: suit). An example of business casual attire would be slacks (no jeans), a nice blouse with or without a jacket or sweater (cardigan).

Rotation Format Prior to Each Rotation:

1. Several days prior to beginning a new rotation contact the Site Coordinator/Preceptor of that rotation and introduce yourself and explain that you will be the intern assigned to them during _________________________ (provide a time frame).

2. Ask the preceptor the following: a. What time should I report for the rotation? b. Where should I meet them? c. Is there any special information I need to know?

During Each Rotation: Please have available copies of all the evaluation forms and the checklist required for that site for the Site Coordinator/Preceptor. Interns are required to complete the objectives and planned experiences/ activities (competencies) during the rotation. Keep track of your rotation competency checklists (found in the folder for that rotation on the MSU myState/myCourses website) and have each Preceptor sign and date each activity as completed. On the first day of the rotation your Site Coordinator/Preceptor should provide you with a tentative schedule of your time with them. Please be timely and professional. Please have all assignments and readings completed as assigned and turn in to the Preceptor on time.

Competency Checklists: Each Site Coordinator/Preceptor has a set of activities and corresponding competencies that you are expected to accomplish at that site. You are to complete all of the competencies set by the 2017 Accreditation Standards by the end of your supervised practice experience. You will most likely repeat some competencies. This will contribute to your proficiency level and it is to be expected. Please remember that what is planned is not always what happens. Planning is important but being flexible is just as important. Your competency checklist is to be completed during your time at that rotation. When planned activities are completed, please ensure that your Preceptor initials and dates the indicated columns, and signs at the bottom of the checklist.

At the End of Each Rotation:

Procedure for Evaluation at Each Site: The following procedure/order will be followed when evaluating student performance and evaluating the rotation/experience at each site:

• Intern will turn in completed Intern Rotation Evaluation form of the site/rotation in a sealed/ signed/dated (across flap on back) envelope to the Site Coordinator and/or Preceptor (or DI Director if Preceptor prefers) on the last day of the rotation.

• Site Coordinator and/or Preceptor will review the Intern Rotation Evaluation after the Intern has left the site.

• Site Coordinator and/or Preceptor will discuss the Intern’s evaluation (Clinical, Food Service 40

Management, or Community) with the Intern on the last day of the rotation.

The Site Coordinator/Preceptor or Intern (if Site Coordinator/Preceptor prefers) will turn in to the DI Director as soon as possible:

1. Completed competency checklist 2. Original assignments, projects, quizzes, etc. 3. Completed, signed, and dated original intern evaluation (Clinical, Food Service Management,

or Community)

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Mississippi State University Dietetic Internship Community Template – Activity and Evaluation Sheet

Intern Name:______________________________ Name of Facility_____________________________________________________

Preceptor: Please initial completed activities and assign an evaluation score for each activity that was completed.

1= needs improvement 2= minimally adequate 3= satisfactory 4= more than satisfactory 5= outstanding N/A= not applicable

ACEND Competencies

Experiences / Activities Evaluation Method

Preceptor’s Initials

Score

CRDN 1.1 Select indicators of program quality and/or customer service and measure achievement of objectives.

Participation

CRDN 1.2 Apply evidence-based guidelines, systematic reviews and scientific literature.

Observation

CRDN 1.3 Justify programs, products, services and care using appropriate evidence or data.

Written

CRDN 1.6 Incorporate critical-thinking skills in overall practice. Observation

CRDN 2.1 Practice in compliance with regulations as applicable and accordance with accreditation standards and the Scope of Dietetics Practice and Code of Ethics for the Profession of Nutrition and Dietetics.

Observation

CRDN 2.2 Demonstrate professional writing skills in preparing professional communications (Education materials, news articles, etc.)

Evaluate intern’s written materials

CRDN 2.3 Demonstrate active participation, teamwork and contributions in group settings.

Observation

CRDN 2.4 Function as a member of interprofessional teams. Observation

CRDN 2.7 Apply leadership skills to achieve desired outcomes. Observation

CRDN 2.10 Demonstrate professional attributes in all areas of practice. Observation

CRDN 2.11 Show cultural competence/sensitivity in interactions with clients, colleagues and staff.

Observation/course

CRDN 3.3 Demonstrate effective communications skills for clinical and customer services in a variety of formats and settings.

Observation

42

_____________________________ _______________ _____________________________ ________________

_____________________________ _______________

CRDN 3.4 Design, implement and evaluate presentations to a target audience Written

CRDN 3.5 Develop nutrition education materials that are culturally and age appropriate and designed for the literacy level of the audience.

Written

CRDN 3.6 Use effective education and counseling skills to facilitate behavior change. Observation CRDN 3.7 Develop and deliver products, programs or services that promote consumer

health, wellness and lifestyle management. Participation

CRDN 3.8 Deliver respectful, science-based answers to client questions concerning emerging trends.

Observation

CRDN 3.9 Coordinate procurement, production, distribution and service of goods and services, demonstrating and promoting responsible use of resources.

Observation

CRDN 3.10 Develop and evaluate recipes, formulas and menus for acceptability and affordability that accommodate the cultural diversity and health needs of various populations, groups and individuals.

Written

CRDN 4.3 Conduct clinical and customer service quality management activities. Participation CRDN 4.6 Propose and use procedures as appropriate to the practice setting to promote

sustainability, reduce waste and protect the environment. Observation

CRDN 4.7 Conduct feasibility studies for products, programs or services with consideration of costs and benefits.

Written

CRDN 4.8 Develop a plan to provide or develop a product, program or service that includes a budget, staffing needs, equipment and supplies.

Written

*At end of rotation, preceptor(s) and intern must sign below. Return sheets to internship director. Comments may be included on back of sheet.

Comments:

Preceptor Signature Date Preceptor Signature Date

Intern Signature Datete

43

Mississippi State University Dietetic Internship Clinical– Activity Sheet

Intern Name: ______________________________ Name of Facility:_____________________________________________________

1= needs improvement 2= minimally adequate 3= satisfactory 4= more than satisfactory 5= outstanding N/A= not applicable

ACEND Competencies

Planned Experience / Activities Evaluation Method

Preceptor’s Initials

Score

CRDN 1.4 Evaluate emerging research for application in nutrition and dietetics practice.

Written

CRDN 1.6 Incorporate critical-thinking skills in overall practice. Observation

CRDN 2.1 Practice in compliance with current federal regulations and state statutes and rules, as applicable, and in accordance with accreditation standards and the Scope of Nutrition and Dietetics Practice and Code of Ethics for the Profession of Nutrition and Dietetics.

Observation

CRDN 2.2 Demonstrate professional writing skills in preparing professional communications.

Written

CRDN 2.3 Demonstrate active participation, teamwork and contributions in group settings

Observation

CRDN 2.4 Function as a member of interprofessional teams. Observation

CRDN 2.5 Assign duties to NDTRs and/or support personnel as appropriate.

Observation

CRDN 2.6 Refer clients and patients to other professionals and services when needs are beyond individual scope of practice.

Observation

CRDN 2.10 Demonstrate professional attributes in all areas of practice.

Observation

CRDN 2.11 Show cultural competence/sensitivity in interactions with clients, colleagues and staff.

Observation

CRDN 3.1 Perform the Nutrition Care Process and use standardized Observation 44

___________________________ _______________ ___________________________ ________________

___________________________ _______________

nutrition language for individuals, groups and populations of differing ages and health status, in a variety of settings.

CRDN 3.2 Conduct nutrition focused physical exams. Observation

CRDN 3.3 Demonstrate effective communications skills for clinical and customer services in a variety of formats and settings.

Observation

CRDN 3.6 Use effective education and counseling skills to facilitate behavior change.

Observation

CRDN 3.8 Deliver respectful, science-based answers to client questions concerning emerging trends.

Observation

CRDN 4.3 Conduct clinical and customer service quality management activities.

Participation

CRDN 4.4 Apply current nutrition informatics to develop, store, retrieve and disseminate information and data.

Observation

CRDN 4.9 Explain the process for coding and billing for nutrition and dietetics services to obtain reimbursement from public or private payers, fee-for-service and value-based payment systems.

Observation

CRDN 4.10 Analyze risk in nutrition and dietetics practice. Written

*At the end of rotation when all activities are completed, preceptors and intern must sign below. Return all activity sheets to internship director.

Comments:

Preceptor Signature Date Preceptor Signature Date

Intern Signature Date

45

Mississippi State University Dietetic Internship MSU Sports Nutrition Rotation – Activity and Evaluation Sheet

Intern Name: ______________________________ Name of Facility:______________________________________________________

Preceptor: Please initial completed activities and assign an evaluation score for each activity that was completed.

1= needs improvement 2= minimally adequate 3= satisfactory 4= more than satisfactory 5= outstanding N/A= not applicable

ACEND Competencies

Experiences / Activities Evaluation Method

Preceptor’s Initials

Score

CRDN 1.3 Justify programs, products, services and care using appropriate evidence or data.

Observation

CRDN 1.6 Incorporate critical-thinking skills in overall practice. Observation CRDN 2.2 Demonstrate professional writing skills in preparing professional

communications (Education materials, news articles, etc.) Evaluate intern’s written materials

CRDN 2.3 Demonstrate active participation, teamwork, and contributions in group settings.

Observation

CRDN 2.4 Function as a member of interprofessional teams. Observation CRDN 2.6 Refer clients and patients to other professionals and services when

needs are beyond individual scope of practice. Observation

CRDN 2.10 Demonstrate professional attributes in all areas of practice. Observation CRDN 2.11 Show cultural competence/sensitivity in interactions with clients,

colleagues and staff. Observation

CRDN 3.5 Develop nutrition education materials that are culturally and age appropriate and designed for the literacy level of the audience.

Observation

CRDN 3.6 Use effective education and counseling skills to facilitate behavior change.

Observation

CRDN 3.7 Develop and deliver products, programs or services that promote consumer health, wellness and lifestyle management.

Written material

CRDN 4.2 Perform management functions related to safety, security, and sanitation that affect employees, customers, patients, facilities, and food. (wearing gloves when handling samples, wearing a face mask,

Observation

46

_____________________________ _______________ _____________________________ ________________

_____________________________ _______________

sanitizing countertops, etc.) CRDN 4.7 Conduct feasibility studies for products, programs, or services with

consideration to costs and benefits. Observation

CRDN 4.10 Analyze risk in nutrition and dietetics practice. Written

*At end of rotation, preceptor(s) and intern must sign below. Return sheets to internship director. Comments may be included on back of sheet.

Comments:

Preceptor Signature Date Preceptor Signature Date

Intern Signature Date

47

Mississippi State University Dietetic Internship MSU Research Rotation – Activity and Evaluation Sheet

Intern Name: ______________________________ Name of Facility:______________________________________________________

Preceptor: Please initial completed activities and assign an evaluation score for each activity that was completed.

1= needs improvement 2= minimally adequate 3= satisfactory 4= more than satisfactory 5= outstanding N/A= not applicable

ACEND Competencies

Experiences / Activities Evaluation Method

Preceptor’s Initials

Score

CRDN 1.2 Apply evidence-based guidelines, systematic reviews and scientific literature.

Written materials

CRDN 1.5 Conduct projects using appropriate research methods, ethical procedures and data analysis.

Written materials

CRDN 2.1 Practice in compliance with current federal regulations and state statutes and rules as applicable, and in accordance with accreditation standards and the Scope of Dietetics Practice and Code of Ethics for the Profession of Dietetics.

Observation

CRDN 2.2 Demonstrate professional writing skills in preparing professional communications (updating information, reviewing papers, etc.)

Evaluate intern’s written materials

CRDN 2.3 Demonstrate active participation, teamwork, and contributions in group settings.

Observation

CRDN 3.3 Demonstrate effective communication skills for clinical and customer services in a variety of formats. (Answering questions before, during, and after the research is being performed to the participants)

Observation

CRDN 4.2 Perform management functions related to safety, security, and sanitation that affect employees, customers, patients, facilities, and food. (wearing gloves when handling samples, wearing a face mask, sanitizing countertops, etc.)

Observation

CRDN 4.4 19. Apply current nutrition informatics to develop, store, retrieve and disseminate information and data.

Observation

48

*At end of rotation, preceptor(s) and intern must sign below. Return sheets to internship director. Comments may be included on back of sheet.

Comments:

_____________________________ _______________ _____________________________ ________________ Preceptor Signature Date Preceptor Signature Date

_____________________________ _______________ Intern Signature Date

49

___________________________ _______________

Mississippi State University Dietetic Internship Class – Activity and Evaluation Sheet

Intern Name: ______________________________ Name of Facility: __________________________________

Preceptor: Please initial completed activities and assign an evaluation score for each activity that was completed.

1= needs improvement 2= minimally adequate 3= satisfactory 4= more than satisfactory 5= outstanding N/A= not applicable

ACEND Competencies

Experiences / Activities Evaluation Method

Preceptor’s Initials

Score

CRDN 2.11 Show cultural competence/sensitivity in interactions with clients, colleagues and staff.

Observation/course

CRDN 2.12 Perform self-assessment and develop goals for self-improvement throughout the program.

written

CRDN 2.13 Prepare a plan for professional development according to Commission on Dietetic Registration guidelines.

written

CRDN 2.14 Demonstrate advocacy on local, state or national legislative and regulatory issues or policies impacting the nutrition and dietetics profession.

participation

CRDN 2.15 Practice and/or role play mentoring and precepting others observation CRDN 2.9 Participate in professional and community organizations. participation

Comments:

___________________________ _______________ ___________________________ ________________ Preceptor Signature Date Preceptor Signature Date

Intern Signature Date

50

Mississippi State University Dietetic Internship Foodservice Rotation – Activity and Evaluation Sheet

Intern Name: ______________________________ Name of Facility_____________________________________________________

Preceptor: Please initial completed activities and assign an evaluation score for each activity that was completed.

1= needs improvement 2= minimally adequate 3= satisfactory 4= more than satisfactory 5= outstanding N/A= not applicable

ACEND Competencies

Experiences / Activities Evaluation Method

Preceptor’s Initials

Score

CRDN 2.1 Practice in compliance with current federal regulations and state statutes and rules, as applicable and accordance with accreditation standards and the Scope of Dietetics Practice and Code of Ethics for the Profession of Nutrition and Dietetics.

Observation

CRDN 2.3 Demonstrate active participation, teamwork and contributions in group settings.

Observation

CRDN 2.4 Function as a member of interprofessional teams. Observation

CRDN 2.5 Assign duties to NDTRs and/or support personnel as appropriate. Observation CRDN 2.8 Demonstrate negotiation skills. Observation

CRDN 2.10 Demonstrate professional attributes in all areas of practice. Observation

CRDN 4.1 Participate in management of human resources. Participation

CRDN 4.2 Perform management functions related to safety, security and sanitation that affect employees, customers, patients, facilities and food.

Participation

CRDN 4.3 Conduct clinical and customer service quality management activities.

Participation

CRDN 4.5 Analyze quality, financial and productivity data for use in planning.

Written

CRDN 4.7 Conduct feasibility studies for products, programs or services with consideration of costs and benefits.

Written

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_____________________________ _______________ _____________________________ _______________

_____________________________ ______________

*At end of rotation, preceptor(s) and intern must sign below. Return sheets to internship director. Comments may be included on back of sheet.

Comments:

Preceptor Signature Date Preceptor Signature Date

Intern Signature Date

52

Mississippi State University Dietetic Internship Clinical Staff Relief Rotation

Intern Name: ______________________________ Name of Facility:_____________________________________________________

1= needs improvement 2= minimally adequate 3= satisfactory 4= more than satisfactory 5= outstanding N/A= not applicable

ACEND Competencies

Planned Experience / Activities Evaluation Method Preceptor’s Initials

Score

CRDN 1.6 Incorporate critical-thinking skills in overall practice. Observation

CRDN 2.1 Practice in compliance with current federal regulations and state statutes and rules, as applicable, and in accordance with accreditation standards and the Scope of Nutrition and Dietetics Practice and Code of Ethics for the Profession of Nutrition and Dietetics.

Observation

CRDN 2.2 Demonstrate professional writing skills in preparing professional communications.

Written

CRDN 2.3 Demonstrate active participation, teamwork and contributions in group settings

Observation

CRDN 2.4 Function as a member of interprofessional teams. Observation

CRDN 2.5 Assign duties to NDTRs and/or support personnel as appropriate.

Observation

CRDN 2.6 Refer clients and patients to other professionals and services when needs are beyond individual scope of practice.

Observation

CRDN 2.10 Demonstrate professional attributes in all areas of practice. Observation CRDN 2.11 Show cultural competence/sensitivity in interactions with

clients, colleagues and staff. Observation

CRDN 3.1 Perform the Nutrition Care Process and use standardized nutrition language for individuals, groups and populations of differing ages and health status, in a variety of settings.

Observation

CRDN 3.2 Conduct nutrition focused physical exams. Observation

CRDN 3.3 Demonstrate effective communications skills for clinical and customer services in a variety of formats and settings.

Observation

53

___________________________ _______________ ___________________________ ________________

___________________________ _______________

CRDN 3.6 Use effective education and counseling skills to facilitate behavior change.

Observation

CRDN 3.8 Deliver respectful, science-based answers to client questions concerning emerging trends.

Observation

CRDN 4.3 Conduct clinical and customer service quality management activities.

Participation

CRDN 4.4 Apply current nutrition informatics to develop, store, retrieve and disseminate information and data.

Observation

CRDN 4.9 Explain the process for coding and billing for nutrition and dietetics services to obtain reimbursement from public or private payers, fee-for-service and value-based payment systems.

Observation

CRDN 4.10 Analyze risk in nutrition and dietetics practice. Written

Culminating Clinical Staff Relief Written/ Observation/ participation

*At the end of rotation when all activities are completed, preceptors and intern must sign below. Return all activity sheets to internship director.

Culminating Staff relieve Score is required

Comments:

Preceptor Signature Date Preceptor Signature Date

Intern Signature Date

54

Intern Rotation Evaluation Department of Food Science, Nutrition, and Health Promotion, Mississippi State University Dietetic Internship

Intern_______________________________ Rotation_______________________________ Date_______

Please complete this form objectively when you complete the rotation. Be honest so we can improve experiences for future interns. When completed, return to the DI Director, who will share evaluations with preceptors after you have graduated from the program.

1. To what extent did this rotation contribute to your professional growth? a. Contributed greatly b. Contributed to some extent c. Contributed little

What suggestions would you make to improve this rotation?

2. What planned experience/activity was the most valuable in this rotation? Why?

3. What planned experience/activity was the least valuable in this rotation? Why?

4. Was there adequate time in this rotation? Yes___ No___ If no, explain:

5. Were you ready for the rotation through classes, readings, etc.? Yes___ No___ If no, explain:

6. Was the preceptor well informed on current trends in the area of expertise? Yes___ No___ If no, explain:

7. Did the preceptor make his/her expectations clear to you? Yes___ No___ If no, explain:

8. Was the preceptor supportive of your efforts to learn? Yes___ No___ If no, explain:

9. Did the preceptor allow you to develop independent judgment and decision-making abilities in this rotation? Yes___ No___ If no, explain:

10. Please give your overall impression of this rotation and additional comments (may use the back).

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Mississippi State University (MSU) Dietetic Internship (DI) Program Graduate Survey Dear Colleague, In order for us to best meet the needs of our students, to ensure continuous program improvement, and to fulfill accreditation requirements, we ask you to please complete the following survey. We appreciate your support and input as essential components of our program. Your individual results will not be shared with anyone. Group results will be used for accreditation purposes only.

1. Have you taken the RD exam? Yes___ No___

2. If you have taken the RD exam, which of the following applies to you:

Passed on first attempt___ Passed on second attempt___ Passed on third attempt___ Have not passed yet___

3. Are you currently employed? Yes___ No___ (If no, skip to question 7)

4. If employed, how many months did it take after program completion for you to secure professional employment?

<3 months___ 4-6 months___ 7-9 months___ 9-12 months___

5. If employed, is your current position full-time or part-time?

Full-time___ Part-time___ If part-time, how many hours in a usual week? __________

6. If employed, please indicate the type/title of the position: _________________________

7. Have you obtained any additional advanced degrees/training/certifications since graduation?

No___ Yes___ If yes, please specify __________________________

8. If you were to do it over again, how likely would you be to choose this program?

Very not likely___ Not likely___ Not sure___ Likely___ Very likely___

9. Please indicate how much you agree or disagree with the following statements regarding the goals of the MSU DI. Goal 1 of the MSU DI is to prepare quality graduates to be competent entry-level dietitians. Goal 2 is to promote a commitment to the pursuit of lifelong learning, research, and community service in the dietetics profession.

How much do you agree or disagree with the following two statements?

I was a prepared quality graduate able to perform as a competent entry-level dietitian.

Strongly agree___ Agree___ Neither agree nor disagree___ Strongly disagree___ Disagree___

I am committed to the pursuit of lifelong learning, research, and community service in the dietetics profession.

Strongly agree___ Agree___ Neither agree nor disagree___ Strongly disagree___ Disagree___

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Please indicate how much you agree or disagree with the following statements: 5 = strongly agree, 4 = agree, 3 = neither agree nor disagree, 2 = disagree, 1 = strongly disagree

Item 5 4 3 2 1 I have the ability to apply current research to the job setting I have knowledge about food so that I can:

translate nutrition needs into menus select recipes and make modifications as needed apply food science principles demonstrate basic food preparation skills

I have knowledge about nutrition so I can: calculate diets for common conditions conduct comprehensive nutrition assessments determine requirements over the lifespan calculate enteral and parenteral nutrition formulations

I have a knowledge base in management so I can: determine costs of services prepare a budget apply marketing principles

I have the ability to interpret lab values related to the population served I have knowledge of current reimbursement issues I have good communication skills I am able to apply course work to the job environment:

in administration in nutritional care

I am able to advice and counsel without direct supervision I can relate to the needs of various ethnic groups I can apply knowledge to a new situation

What year did you graduate from the MSU DI?

Please feel free to provide any comments about the MSU DI

Thank you for your time and input!

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Intern Competency Checklist

The competency checklists contain all of the competencies you are expected to accomplish in your supervised practice experiences (also called rotations). Most of them will be met at several rotations but each one must be met in at least one rotation. These checklists provide you with what you are expected to complete at each rotation. Please remember that what is planned does not always happen. Planning is important but being flexible is just as important. Your competency checklist is to be completed during your time at that rotation and you should be self-motivated to ensure that the competencies are completed. The checklists are to help you ensure that you are meeting the competencies. When a planned activity is completed, please ensure that your preceptor initials and dates the appropriate columns. The preceptors are also to sign at the bottom of the checklist.

PRIOR TO EACH ROTATION: 1. Several days prior to beginning a new rotation contact the preceptor of that rotation and

introduce yourself and explain to the preceptor that you will be the intern assigned to them during (provide a time frame).

2. Ask the preceptor: a. What time you should report for the rotation? b. Where you should meet them? c. Are there any other special information or requirements?

DURING EACH ROTATION: Interns are required to complete the objectives and planned experiences/activities during the rotation. Keep track of your rotation competency checklists and have preceptor sign and date each activity as completed. On the first day of the rotation your preceptor should provide you with a tentative schedule of your time with them. Please be timely and professional. Please have all assignments and readings completed as assigned and turn in to preceptor on time.

AT THE END OF EACH ROTATION: At the end of the rotation evaluations must be completed. The intern is to complete a Rotation Evaluation. This evaluation is kept confidential and is to be turned in to the Dietetic Internship Director. The preceptor is to complete the appropriate evaluation for the rotation and review it with the intern. The intern will sign and date, and the preceptor will return the evaluation to the Site Coordinator. The Site Coordinator will then turn in all evaluations, completed and signed checklists and assignments to the Dietetic Internship Director.

At the end of the rotation the rotation competency checklist must be completed with signatures and dates. All assignments/projects/quizzes must be turned in with the checklist (if not beforehand, to be determined by preceptor) to the Dietetic Internship Director.

The Site Coordinator will turn in to Dietetic Internship Director: 1. Completed Competency Checklist 2. Original assignments, projects, quizzes, etc. 3. Completed, signed and dated evaluation (original)

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Dietetic Intern Immunization Form

To be completed prior to Intern beginning his/her rotations at facilities. Check appropriate boxes and provide complete information.

NAME OF INTERN (please print): _________________________________________

1. M.M.R. (MEASLES, MUMPS, RUBELLA) are given instead of individual immunizations.

____ Born before 1957 Must have proof of two does Measles, one dose Rubella and one dose Mumps. DATE: _______________

Born after 1957 ____ Must have proof of one dose of MMR or positive titer to Rubella and Rubeola. ____ Evidence of immunity by Rubella and Rubeola immune titers

Rubbella titer DATE: _____________ AND Rubeola titer DATE: __________

2. TUBERCULOSIS – TB TEST MUST HAVE BEEN GIVEN WITHIN SIX (6) MONTHS

____ Tuberculin skin test: Positive _____ Negative ______ DATE: ________ ____ If positive have you:

1. Had a chest x-ray? Negative. ____ Positive. ______ DATE: _________ 2. Been treated with Anti-Tubercular Drugs?_____Yes _____NO DATE: _________

3. VARICELLA (CHICKENPOX) ____ Had disease or positive immune titer (Specify date of titer) DATE: _________ ____ Have not had disease ____ Have had vaccine DATE: _________

4. HEPATITIS B VACCINE Evidence of Hepatitis B vaccine for all direct patient care providers. Facility Coordinator to determine if Hepatitis B vaccine is required (see Infection Control Manual “Exposure Control Plan”).

____ Hepatitis B vaccine required? _______YES _______NO SERIES DATE: 1. ______________2. _____________ 3.______________

It is the responsibility of the Intern to immediately contact the Facility Coordinator, Facility’s Employee Health Department, and the Dietetic Internship Director if the Participant:

a. is exposed to Varicella (Chickenpox) or Shingles with a negative history of Varicella; b. is exposed to Measles, Mumps, or Rubella, if not immunized; c. is exposed to Pertussis (Whooping Cough); and/or d. acquires any of the above

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_______________________________________ ____________________________________

______________________________________ ____________________________________

HEALTHCARE CRIMINAL HISTORY BACKGROUND AFFIDAVIT

State of Mississippi, County of ________________________________

Before me, a Notary Public in and for the County and State aforesaid, personally appeared the undersigned __________________________, who, after being by me first duly sworn did state upon his/her oath as follows:

a. That the affiant is currently employed by ________________________________, a licensed facility/entity by the Mississippi State Department of Health, or by another entity employed by a licensed facility/entity on a contractual basis.

b. That the affiant has not been convicted of or pleaded guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, sex offense listed in Section 45-33-23(f), Mississippi Code of 1972, child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult.

c. That the affiant has not been convicted of or pleaded guilty or nolo contendere to other crimes which his/her employer (1) has determined to be of a nature and/or frequency as to be disqualifying for employment; (2) has adopted such as part of its written policies; and (3) has fully disclosed of such to the affiant prior to his/her requirement during his/her employment, in addition to this affidavit.

d. Further, the affiant sayeth not.

Name of Affiant (printed) Signature of Affiant

SWORN TO AND SUBSCRIBED BEFORE ME, this the ____ day of _____________, 20____

Signature of Notary Public My Commission Expires

Mississippi State Department of Health Form #210

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Important Contact Information

Dietetic Internship Director:

Terezie Tolar Mosby, EdD, MS, RD, LD, FAND Department of Food Science, Nutrition & Health Promotion 204 Herzer Building on Stone Blvd. Mississippi State University – Starkville Campus terezie.mosby@msstate.edu Office phone: 662-325-5902 Department phone: 662-325-3200 FAX: 662-325-8728 Dietetic interns are provided with Dr. Mosby’s cell phone numbers

Mailing address: Dr. Terezie T. Mosby Box 9805 945 Stone Blvd, Herzer Building Mississippi State, MS 39762

Other helpful resources: University Police 662-325-2121 Longest Student Health Services 662-325-2431 Student Counseling Services 662-325-2091 or 662-325-3333 (emergencies) OCH Regional Medical Center 662-323-4320 Starkville Police Department 662-323-4131 Oktibbeha County Sheriff’s Office 662-323-2421 Mississippi State Highway Patrol Office (Starkville) 662-323-5315 Fire Department 662-323-1212

Mississippi State University: Office of the Graduate School 662-325-7400 grad@grad.msstate.edu Financial Aid 662-325-2450 financialaid@saffairs.msstate.edu Career Center 662325-3344 career@career.msstate.edu Testing Services 662-325-6610 testing@saffairs.msstate.edu The Learning Center (tutoring services) 662-325-2957 tlc@colled.msstate.edu

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Dietetic Intern Handbook Form

I, (print your name) _____________________________________, confirm that I have received and read the Mississippi State University Dietetic Internship Handbook. I am aware that it is my responsibility to understand and adhere to the information stated in the Handbook. If I have questions regarding any part of the content of the Handbook, I am aware that it is my responsibility to seek clarification from the Dietetic Internship Director.

Signature__________________________________________

Today’s Date_____________

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